Effects of different moxibustion durations on lumbar disk herniation: a clinical study
Article Category: Original article
Published Online: Mar 26, 2024
Page range: 47 - 56
Received: Jan 13, 2023
Accepted: Apr 25, 2023
DOI: https://doi.org/10.2478/fon-2024-0005
Keywords
© 2024 Bin Chen et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Lumbar disk herniation (LDH) refers to the disease of lumbar annulus fibrosus, which causes the nucleus pulposus to deviate from the normal position and protrude outward, stimulating the local nerve roots and resulting in inflammation, and is mainly manifested as low back pain and limited function.1 The incidence rate of LDH has reached 20%-30%, which has affected the quality of life and increased the financial burden of patients.2
The etiology of LDH mainly includes lumbar degenerative changes, overload, injury, and so on.3 At present, the treatment methods in the western system of medicine for LDH are mainly surgical and drug treatment. However, spinal surgical trauma may lead to postoperative low back pain, spinal instability, and sometimes recurrent disk herniation.4 In addition, some studies have shown that the medium and long-term effect of surgical treatment is not ideal.5 Long-term use of drugs can produce certain side effects on the kidney, cardiovascular, and gastrointestinal systems, thus long-term use is not recommended.6 The efficacy or cost-effectiveness of western medicine in the treatment of LDH is controversial, and there are certain risks involved.7 Therefore, there are still great challenges in the treatment of LDH, and new treatment methods need to be found.
In traditional Chinese medicine (TCM), LDH is associated with “low back pain.”8 Moxibustion causes a warm effect by burning moxa velvet, to stimulate corresponding acupoints, so as to achieve the effects of warming and dredging meridians, removing cold and dampness, and relieving arthralgia and pain.9 Starting from the holistic view of TCM and based on the theory of meridians and acupoints, moxibustion therapy is especially good at tonifying the deficiency of healthy
Moxibustion therapy has a long history. Because of its simple operation, low price, adequate safety, sufficient effectiveness, and good effects on LDH, it is worthy of in-depth research and clinical promotion of modern medicine.11 However, through consulting and sorting out the literature, it is found that the specific implementation forms of moxibustion therapy (such as moxibustion time) are inconsistent with lack of standards, which limits the popularization and application of moxibustion in the clinic.12,13 The purpose of this study is to explore the best moxibustion time by comparing the effects of different moxibustion time on the treatment of LDH.
The diagnostic criteria of LDH in surgery (9th Edition) (People’s Health Publishing House) in 2018 include the following: (1) low back pain could be accompanied by sciatica, radiating to the hip, thigh, lower leg, dorsum of foot or lateral foot, and can have numbness; (2) sensory abnormalities in the sellar region could be seen in those who compress the cauda equina nerve; (3) lumbar scoliosis and lumbar movement are unfavorable, and there are obvious tenderness points between the spinous processes; (4) straight leg elevation test was positive; (5) sensory disturbance of skin on the outside of lower leg or dorsum of foot, decreased muscle strength of toe, and decreased or disappeared achilles tendon reflex on the affected side; (6) X-ray examination shows physiological radian straightened or disappeared, intervertebral space narrowed; and (7) Computer Tomography (CT), Magnetic Resonance Imaging (MRI), or myelography shows LDH, protrusion or prolapse, and other morphological abnormalities, which could clearly diagnose and determine the protrusion site.
The syndrome differentiation of TCM for LDH includes the blood stasis type, cold dampness type, and yang deficiency type of liver and kidney deficiency in the diagnostic standard of TCM issued by the State Administration of TCM in 1994.
The inclusion criteria are as follows: (1) The diagnostic criteria of LDH include blood stasis type, cold dampness type, or yang deficiency of liver and kidney deficiency in surgery and diagnostic efficacy criteria of TCM syndrome; (2) patients with LDH are diagnosed by CT and MRI; (3) those aged 18–70 years, regardless of gender; and (4) informed consent to this treatment. Patients read and signed the informed consent form before treatment.
The exclusion criteria are as follows: (1) Accompanied by lumbar spinal stenosis; (2) patients with symptoms of LDH and compression of the cauda equina nerve; (3) accompanied by severe osteoporosis, lumbar tuberculosis, or tumor; (4) local skin blisters, ulceration, or infection; (5) persons with mental disorders who could not be treated; (6) patients with severe parenchymal organ dysfunction; and (7) pregnant or lactating women.
The elimination and dropout criteria are as follows: (1) Those who have serious adverse events and need to stop the clinical trial; (2) if the clinical symptoms do not decrease or worsen, or other diseases and syndromes affect the test observer, the test shall be stopped immediately; (3) patients with poor compliance during the trial and difficult to evaluate the curative effect; and (4) those who are unwilling to continue the clinical trial during the implementation.
SPSS 25.0 statistical software (IBM Corporation, Armonk, New York, United States) was used for data processing. All data were tested by two-sided test.
A total of 88 hospitalized patients with LDH were from the Department of Orthopedics and Traumatology of the hospital from April 2021 to November 2021. All patients were randomly divided into 4 groups with 22 patients in each group. There was no significant difference in gender, age, height, weight, course of disease, educational level, and TCM classification among the 4 groups (
Characteristics of patients at baseline.
| Items | Control group ( |
15-min moxibustion group ( |
30-min moxibustion group ( |
45-min moxibustion group ( |
||
|---|---|---|---|---|---|---|
| 0.918 | ||||||
| Male | 11 | 9 | 10 | 11 | ||
| Female | 11 | 13 | 12 | 11 | ||
| 52.50 ± 12.54 | 54.73 ± 11.23 | 50.59 ± 13.47 | 51.59 ± 12.10 | 0.719 | ||
| 165.68 ± 7.63 | 166.68 ± 7.40 | 165.59 ± 7.37 | 165.36 ± 8.68 | 0.946 | ||
| 67.95 ± 10.73 | 70.59 ± 11.67 | 66.82 ± 12.91 | 69.59 ± 12.39 | 0.729 | ||
| 21 (11.25–63.00) | 18 (10.00–51.00) | 18 (4.50–63.00) | 12 (4.00–75.00) | 0.961 | ||
| 0.400 | ||||||
| Primary school and below | 2 (9.1%) | 4 (18.2%) | 1 (4.5%) | 1 (4.5%) | ||
| Middle school | 12 (54.5%) | 12 (54.5%) | 8 (36.4%) | 9 (40.9%) | ||
| College degree | 2 (9.1%) | 3 (13.6%) | 7 (31.8%) | 7 (31.8%) | ||
| Bachelor degree or above | 6 (27.3%) | 3 (13.6%) | 6 (27.3%) | 5 (22.7%) | ||
| 0.897 | ||||||
| Blood stasis type | 8 (36.4%) | 8 (36.4%) | 10 (45.5%) | 11 (50.0%) | ||
| Cold dampness type | 9 (20.9%) | 11 (50.0%) | 8 (36.4%) | 7 (31.8%) | ||
| Yang deficiency type of liver and kidney deficiency | 5 (22.7%) | 3 (13.6%) | 4 (18.2%) | 4 (18.2%) | ||
| 5.09 ± 1.07 | 4.82 ± 1.30 | 4.68 ± 1.32 | 4.64 ± 1.26 | 0.617 | ||
| 14.45 ± 1.95 | 13.82 ± 2.46 | 14.32 ± 2.19 | 13.05 ± 2.15 | 0.143 | ||
| 11.77 ± 2.18 | 12.55 ± 2.18 | 11.95 ± 1.76 | 12.50 ± 1.87 | 0.484 |
Routine anti-inflammatory, analgesic, and detumescence treatment for LDH was given, and 20% mannitol (trade name: mannitol injection, 250 mL: 50 mg, State Food and Drug Administration approval number: h20003300, Shanghai Baite Medical Supplies Co., Ltd., Shanghai, China) at 250 mL and dexamethasone sodium phosphate (trade name: dexamethasone sodium phosphate injection, 1 mL: 5 mg, State Food and Drug Administration approval number: h37021969, Chenxin Pharmaceutical Co., Ltd., Hainan, China) of 5 mg was given, intravenous drip, once a day, and celecoxib capsule (200 mg/capsule, State Food and Drug Administration approval number: j20120063, Pfizer Pharmaceutical Co., Ltd., New York, United States) 1 capsule, oral, twice a day for 7 consecutive days; after 7 d, mannitol and dexamethasone were stopped, and celecoxib capsules were taken orally for 7 d. The treatment lasted 14 d.
Based on the treatment of the control group, the patients were treated with moxibustion at “Yaoyangguan,” bilateral “Shenshu,” and bilateral “Weizhong” points every day for 15 min, for a total of 14 d.
Based on the treatment of the control group, the patients were treated with moxibustion at “Yaoyangguan,” bilateral “Shenshu,” and bilateral “Weizhong” points every day for 30 min, for a total of 14 d.
Based on the treatment of the control group, the patients were given daily moxibustion at “Yaoyangguan,” bilateral “Shenshu,” and bilateral “Weizhong” points for 45 min each time for 14 d.
According to the point selection and positioning standard of the World Health Organization, take “Yaoyangguan” (GV3) and place it at the depression under the spinous process of the fourth lumbar spine in the posterior median line, which is level with the iliac crest; bilateral “Shenshu” (BL23), under the spinous process of the second lumbar spine, with a side opening of 1.5 in.; bilateral “Weizhong” (BL40), behind the knee, at the midpoint of the transverse stria of the popliteal fossa.
Cut the moxa stick into small sections about 4-cm long, fix it in the moxibustion box, ignite the lower end of the moxa stick, and fix the moxibustion box 3 cm away from “Yaoyangguan,” bilateral “Shenshu,” and bilateral “Weizhong” points for fumigation. Before operation, inform the patient about the operation purpose and precautions, assist the patient in taking the prone position, check whether the local skin is intact, and accurately select acupoints. Avoid moxibustion on an empty stomach or immediately after meals to prevent discomfort. Adjust the air conditioner to the appropriate temperature, keep warm during moxibustion in winter to prevent cold, and prevent heatstroke in summer. Ask the patient about the warm condition in time during the operation to prevent scalding or insufficient heat. After moxibustion, check the skin again and open the window for ventilation in time. In case of any adverse reaction during operation, it shall be handled and recorded in time.
Visual analog scale (VAS) score was used to evaluate the patients’ low back pain.14 Ask the patient to select the corresponding number on the scale marked with 0–10 according to their own pain feeling (0 = no pain; 10 = unbearable pain). The higher the value, the more intense the pain.
Roland Morris Disability Questionnaire (RMDQ) score was used to evaluate the dysfunction of patients.15 The questionnaire contained 24 sentences that bring inconvenience to life due to low back discomfort. The patients simply answered “yes” or “no” (yes = 1; no = 0). The lowest total score was 0 point and the highest was 24 points. The higher the score, the more serious the dysfunction.
Japanese Orthopaedic Association (JOA) score was used to evaluate the lumbar function.16 The questionnaire contains 3 symptoms (low back pain, leg pain or numbness, and gait); 3 signs (straight leg elevation test, sensory impairment, and motor impairment); and 7 daily activities (lying position, turning over, standing, washing, flexion, sitting position, weightlifting, and walking) and bladder function. The maximum total score was 29. The higher the score, the better the lumbar function.
The evaluation was conducted according to the relevant standards in the diagnostic criteria for diseases and syndromes of TCM, including: (1) Recovery: the waist and leg pain completely disappeared, the straight leg elevation test was negative, and the daily life and work recovered as usual; (2) Remarkable effect: the waist and leg pain basically disappeared, the straight leg elevation test could reach 70°, and the daily life and work basically returned to normal; (3) Effective: waist and leg pain partially disappeared, activity was slightly limited, straight leg elevation test was improved compared with that before treatment, and daily mild activities could be carried out; (4) Ineffective: there was no change or aggravation of low back and leg pain, unable to carry out daily activities. Effective rates = (cured + markedly effective + effective)/total number of cases ×100%.
The simple effect analysis results of the 4 groups of patients are shown in Table 2. Before intervention, there was no significant difference in VAS score among the 4 groups (
Simple effect analysis of VAS score in the 4 groups.
| Time point | Mean difference | Standard error | |||
|---|---|---|---|---|---|
| T1 | Control group | 15-min moxibustion group | 0.273 | 0.374 | 0.977 |
| Control group | 30-min moxibustion group | 0.409 | 0.374 | 0.857 | |
| Control group | 45-min moxibustion group | 0.455 | 0.374 | 0.787 | |
| 15-min moxibustion group | 30-min moxibustion group | 0.136 | 0.374 | 0.999 | |
| 15-min moxibustion group | 45-min moxibustion group | 0.182 | 0.374 | 0.997 | |
| 30-min moxibustion group | 45-min moxibustion group | 0.045 | 0.374 | 1.000 | |
| T2 | Control group | 15-min moxibustion group | 0.682 | 0.362 | 0.323 |
| Control group | 30-min moxibustion group | 2.182 | 0.362 | <0.001 | |
| Control group | 45-min moxibustion group | 2.136 | 0.362 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | 1.500 | 0.362 | <0.001 | |
| 15-min moxibustion group | 45-min moxibustion group | 1.455 | 0.362 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | –0.045 | 0.362 | 1.000 | |
| T3 | Control group | 15-min moxibustion group | 0.773 | 0.375 | 0.229 |
| Control group | 30-min moxibustion group | 1.818 | 0.375 | <0.001 | |
| Control group | 45-min moxibustion group | 2.273 | 0.375 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | 1.045 | 0.375 | 0.039 | |
| 15-min moxibustion group | 45-min moxibustion group | 1.500 | 0.375 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | 0.455 | 0.375 | 0.790 |
The simple effect analysis results of the 4 groups of patients are shown in Table 3. Before intervention: There was no significant difference in RMDQ score among the 4 groups (
Simple effect analysis of RMDQ scores in four groups.
| Time point | Mean difference | Standard error | |||
|---|---|---|---|---|---|
| T1 | Control group | 15-min moxibustion group | 0.636 | 0.662 | 0.917 |
| Control group | 30-min moxibustion group | 0.136 | 0.662 | 1.000 | |
| Control group | 45-min moxibustion group | 1.409 | 0.662 | 0.198 | |
| 15-min moxibustion group | 30-min moxibustion group | –0.500 | 0.662 | 0.973 | |
| 15-min moxibustion group | 45-min moxibustion group | 0.773 | 0.662 | 0.816 | |
| 30-min moxibustion group | 45-min moxibustion group | 1.273 | 0.662 | 0.300 | |
| T2 | Control group | 15-min moxibustion group | 1.227 | 0.673 | 0.361 |
| Control group | 30-min moxibustion group | 2.409 | 0.673 | 0.003 | |
| Control group | 45-min moxibustion group | 4.636 | 0.673 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | 1.182 | 0.673 | 0.405 | |
| 15-min moxibustion group | 45-min moxibustion group | 3.409 | 0.673 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | 2.227 | 0.673 | 0.008 | |
| T3 | Control group | 15-min moxibustion group | 2.091 | 0.715 | 0.026 |
| Control group | 30-min moxibustion group | 5.455 | 0.715 | <0.001 | |
| Control group | 45-min moxibustion group | 6.500 | 0.715 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | 3.364 | 0.715 | <0.001 | |
| 15-min moxibustion group | 45-min moxibustion group | 4.409 | 0.715 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | 1.045 | 0.715 | 0.615 |
At 1 week of intervention: There was no significant difference in RMDQ score between the control and 15-min moxibustion groups (
At 2 weeks of intervention: Compared with the control group, the RMDQ scores of patients in the 15-min, 30-min, and 45-min moxibustion groups were significantly lower (
The simple effect analysis results of the 4 groups of patients are shown in Table 4. Before intervention: There was no significant difference in JOA score among the 4 groups (
Simple effect analysis of JOA scores in four groups.
| Time point | Mean difference | Standard error | |||
|---|---|---|---|---|---|
| T1 | Control group | 15-min moxibustion group | –0.773 | 0.605 | 0.747 |
| Control group | 30-min moxibustion group | –0.182 | 0.605 | 1.000 | |
| Control group | 45-min moxibustion group | –0.727 | 0.605 | 0.795 | |
| 15-min moxibustion group | 30-min moxibustion group | 0.591 | 0.605 | 0.911 | |
| 15-min moxibustion group | 45-min moxibustion group | 0.045 | 0.605 | 1.000 | |
| 30-min moxibustion group | 45-min moxibustion group | –0.545 | 0.605 | 0.937 | |
| T2 | Control group | 15-min moxibustion group | –1.091 | 0.599 | 0.362 |
| Control group | 30-min moxibustion group | –4.273 | 0.599 | <0.001 | |
| Control group | 45-min moxibustion group | –4.682 | 0.599 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | –3.182 | 0.599 | <0.001 | |
| 15-min moxibustion group | 45-min moxibustion group | –3.591 | 0.599 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | –0.409 | 0.599 | 0.984 | |
| T3 | Control group | 15-min moxibustion group | –4.318 | 0.857 | <0.001 |
| Control group | 30-min moxibustion group | –6.909 | 0.857 | <0.001 | |
| Control group | 45-min moxibustion group | –8.227 | 0.857 | <0.001 | |
| 15-min moxibustion group | 30-min moxibustion group | –2.591 | 0.857 | 0.020 | |
| 15-min moxibustion group | 45-min moxibustion group | –3.909 | 0.857 | <0.001 | |
| 30-min moxibustion group | 45-min moxibustion group | –1.318 | 0.857 | 0.559 |
At 1 week of intervention: There was no significant difference in JOA scores between the control and 15-min moxibustion groups (
At 2 weeks of intervention: Compared with the control group, the JOA scores of patients in the 15-min, 30-min, and 45-min moxibustion groups were significantly higher (
The effective rates were 57.9% (14/22) in the control group, 77.3% (17/22) in the 15-min moxibustion group, 90.9% (20/22) in the 30-min moxibustion group, and 95.5% (21/22) in the 45-min moxibustion group. There was no significant difference in the effective rates between the control and 15-min moxibustion groups (
Comparison of clinical efficacy after treatment in four groups.
| Group | Clinical efficacy | Effective rate | |||||
|---|---|---|---|---|---|---|---|
| Recovery | Remarkable effect | Effective | Invalid | ||||
| Control group | 1 (4.5%) | 3 (13.6%) | 10 (45.5%) | 8 (36.4%) | 57.9% | 10.266 | 0.013 |
| 15-min moxibustion group | 1 (4.5%) | 9 (40.9%) | 7 (31.8%) | 5 (22.7%) | 77.3% | ||
| 30-min moxibustion group | 3 (13.6%) | 11 (50.0%) | 6 (27.3%) | 2 (9.1%) | 90.9% | ||
| 45-min moxibustion group | 5 (22.7%) | 13 (59.1%) | 3 (13.6%) | 1 (4.5%) | 95.5% | ||
In this study, VAS was used to evaluate the low back pain of patients. The results of simple effect analysis between groups showed that at 1 week and 2 weeks of intervention, the control and 15-min moxibustion groups had the same effect on relieving low back pain in patients with LDH, while the 30-min and 45-min moxibustion groups were better than the control and 15-min moxibustion groups, but there was no significant difference between the 30-min and 45-min moxibustion groups on relieving low back pain. This result shows that conventional western medicine treatment and conventional western medicine treatment combined with moxibustion can alleviate the pain symptoms of patients to varying degrees, but the effect of conventional western medicine treatment and western medicine combined with moxibustion for 15 min is equivalent, that is, moxibustion for 15 min can not significantly alleviate the symptoms of low back pain. However, when the duration of moxibustion is increased to 30 min, the pain symptoms of patients can be significantly relieved, while when the duration of moxibustion is increased to 45 min, the pain relief effect will not increase. This may be because the duration of moxibustion for 30 min has reached the saturation moxibustion volume for the relief of low back pain, so the effect will not increase, indicating that 30 min of moxibustion is the best duration for relief of low back pain in patients with LDH.
At present, the mechanism of moxibustion analgesia has attracted increasing attention. Clinical studies have also shown that moxibustion can effectively alleviate low back pain.17 Modern medicine believes that the analgesic effect of moxibustion may be closely related to the warm effect and infrared radiation effect produced in the process of moxibustion.18 The warming effect can increase the blood volume of local microcirculation, and even improve the blood flow velocity, vascular morphology, and diameter; promote the release of nitric oxide; and effectively relieve pain.19 In addition, some studies have confirmed that moxibustion will produce thermal radiation stimulation dominated by infrared rays, which can provide the energy required for cell activities of the body. It can also play an anti-inflammatory and analgesic role by promoting local exudation and absorption and alleviating the oppression and stimulation to the tissue.20
In this study, RMDQ was used to evaluate the dysfunction of patients. The results of simple effect analysis between groups showed that at the first week of intervention, the control, 15-min moxibustion, and 30-min moxibustion groups had the same effect on improving the dysfunction of LDH patients, while the 30-min and 45-min groups were significantly better than the control group, and the curative effect of 45-min moxibustion was also better than that of 15-min and 30-min moxibustion; at 2 weeks of intervention, the 15-min, 30-min, and 45-min moxibustion groups could better improve the dysfunction of patients than the control group, and the effects of 30-min and 45-min moxibustion were more significant than that of 15-min moxibustion, but the effects of 30-min and 45-min moxibustion were the same. This result showed that both conventional western medicine treatment and conventional western medicine combined with moxibustion could improve the dysfunction of LDH patients to varying degrees, the effect of western medicine combined with moxibustion was more significant, and the curative effect could increase with the increase of moxibustion duration. Moxibustion for 30 min and 45 min were better than moxibustion for 15 min. However, the results showed that when the duration of moxibustion is increased to 45 min, the effect was equivalent to that of 30 min moxibustion. This may be because the duration of 30-min moxibustion has reached the saturation moxibustion volume, so the curative effect could not increase. Therefore, it can be considered that 30-min moxibustion is the best time to improve the dysfunction of patients with LDH.
The RMDQ score evaluates the patient’s dysfunction by describing that the patient may have some life inconvenience when a patient has low back discomfort. The results of this study showed that moxibustion could effectively improve the dysfunction of patients, which was also reflected in the previous study. The results of a randomized controlled trial study showed that both thermal moxibustion and mild moxibustion could significantly reduce the RMDQ score of patients with low back pain and improve the dysfunction of patients.21 This may be because when the patient’s pain symptoms are relieved, the dysfunction will also be improved to some extent. Some studies have shown that dysfunction may be related to pain, which may hinder patients from daily activities in life, such as walking and turning over.22 This study showed that moxibustion could significantly alleviate patients’ low back pain, so patients’ dysfunction can also be improved.
JOA score was used to evaluate the lumbar function of patients. The results of simple effect analysis between groups showed that the JOA score of the 15-min moxibustion group was not significantly higher than that of the control group at the first week of intervention, while the JOA score of the 30-min and 45-min moxibustion groups were significantly higher than that of the control and 15-min moxibustion groups, but the effects of the 30-min and 45-min moxibustion groups were the same. At 2 weeks of intervention, compared with the control group, the JOA score of patients in the three moxibustion groups were significantly increased, and moxibustion for 30 min and 45 min was significantly better than moxibustion for 15 min, while moxibustion for 30 min and 45 min had the same effect. This result shows that the JOA score of patients can be significantly improved after 2 weeks of conventional western medicine treatment, and moxibustion combined with western medicine treatment can significantly improve the JOA score of patients than single western medicine treatment, and the curative effects of 30-min and 45-min moxibustion are better than that of 15-min moxibustion, but the therapeutic effect of 30-min moxibustion is equivalent to that of 45-min moxibustion, suggesting that after 30-min moxibustion, if we continue to increase the duration of moxibustion intervention, the curative effect will not increase. Therefore, it is considered that moxibustion for 30 min is the best duration to improve the JOA score in patients with LDH.
JOA score was used to evaluate the lumbar function by evaluating 3 subjective symptoms, 3 clinical signs, and 7 daily activities. Moxibustion promotes blood circulation through warm stimulation, accelerates the regression of inflammation and edema, plays a positive role in relieving muscle spasm, significantly improves the pain symptoms of patients, increases the activity range of the waist and legs, and controls the positive rate of the straight leg elevation test. The results of this study are consistent with the results of a previous clinical study.23 This study compared the effects of moxibustion for 15 min and 40 min on the JOA score of patients. The results show that the moxibustion group for 40 min is better than the moxibustion group for 15 min, but this study did not compare the 30 min moxibustion with moxibustion for 15 min and 40 min.24 In addition, from the VAS score and RMDQ score results, it is seen that moxibustion can significantly alleviate patients’ pain and improve dysfunction, which is consistent with the fact that moxibustion can significantly improve patients’ JOA score.
The clinical efficacy of this study was evaluated according to the relevant standards of diagnostic criteria of TCM diseases and syndromes. The results showed that there was no significant difference in the effective rates between the control and 15-min moxibustion groups, but the effective rates of the 30-min and 45-min moxibustion groups were higher than that of the control group, but there was no significant difference in the effective rates among the 15-min, 30-min, and 45-min moxibustion groups. This result shows that moxibustion can improve the total effective rates of LDH, which is similar to a previous meta-analysis.25 Although the analysis results show that there is no significant statistical difference in the effect of different moxibustion durations on the clinical effective rates, from the perspective of the number of cured and effective people, the 30-min and 45-min moxibustion groups are more than the 15-min moxibustion group. However, because the sample size of this study is not large enough, the number of the 4 curative effects is relatively small, and the results are not accurate enough, larger sample studies are needed in the future to explore the impact of different moxibustion durations on the clinical efficiency of LDH patients.
During the course of this study, 1 patient in the 45-min moxibustion group had slight skin erythema during one moxibustion. The moxibustion was removed on the same day, the patient returned to normal the next day, and continued to be treated with moxibustion. No adverse reactions occurred in other groups. Therefore, it can be considered that moxibustion therapy is relatively safe and will not cause serious adverse reactions.
This clinical trial study showed that the 30-min moxibustion group was better than the 15-min moxibustion group in relieving pain, improving dysfunction, and improving the JOA score of patients with LDH, and the effect of 30-min moxibustion was equivalent to that of 45-min moxibustion. Therefore, 30-min moxibustion is the best intervention time. In terms of efficiency index, moxibustion also shows superior effect, but different moxibustion durations have no significant effect on this efficiency; moxibustion intervention did not cause serious adverse reactions during the study, which was relatively safe and reliable. However, there were some shortcomings: (1) the sample size of this study was not large enough, and the research objects came from the same hospital, which affected the accuracy of the results to a certain extent. Therefore, a large sample, multicenter randomized controlled study could be carried out in the future to further explore the effect of different moxibustion durations on LDH. (2) In this study, the curative effect was observed only at the time nodes before intervention: 1 week and 2 weeks of intervention. Without long-term follow-up, the long-term curative effect of moxibustion cannot be understood. Therefore, in future research, patients after moxibustion intervention can be followed up for a long time to evaluate the long-term effects of moxibustion.
This study explored the best duration of moxibustion by comparing the effects of different durations on the treatment effect of LDH patients, in order to find the moxibustion operation method based on the best efficacy and provide a basis for clinical moxibustion operation, promote the formation of standardization of TCM nursing technology, and promote the continuous improvement of TCM nursing technology.
Meanwhile, there are some limitations: (1) the research subjects are from the same hospital, which affects the accuracy of the results to some extent. Therefore, a multicenter randomized controlled study can be carried out in the future to further explore the effect of different moxibustion duration on LDH. (2) In this study, we only observed the efficacy of moxibustion at 3 time points: before, 1 week after, and 2 weeks after the intervention, without long-term follow-up, so we could not understand the long-term efficacy of moxibustion. Therefore, in the future research, long-term follow-up can be carried out for patients after moxibustion intervention to evaluate the long-term effect of moxibustion.